\section{Insurer Risk And Maximum Sustainable Benefits}
\label{sec:InsurerRiskandMaximumSustainableBenefits}

No two insurers offer exactly the same benefits because each insurer has unique claims settlement policies and mprocedures. Some insurers contest many claims and some insurers contest very few claims. Some insurers settle claims quickly, within hours or days, and other insurers settle claims very slowly, taking days, or weeks, to settle the most routine claims.

I now compare insurers' Maximum Sustainable Benefits ($MSB_N$) when matching $PI$'s probabilities of: Profits of at least 5\%; or Avoiding operating losses. Each constraint produces different $MSB_N$s. Until now, insurers paid identical benefits, to efficient providers, for identical symptoms. But Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Rows 4 and 5, revealed that larger and smaller insurers have different probabilities of earning profits, or avoiding operating losses, than $PI$, so they cannot offer identical benefits \emph{and} match $PI$'s profitability or loss avoidance performance.

The highest level of benefits any insurer can provide, as do the probabilities of earning profits and avoiding losses, depend on the degree of variation in their Population Loss Ratio Estimates. Very large insurers, because their Population Loss Ratio Estimates tend to lie very close to the Population Loss Ratio, can offer higher benefits without harming their prospects of profitabiulity or incurring operating losses. Smaller insurers, because thewy have higher levels of variation in the Population Loss Ratio Estimates, must cut back on benefits to assure themselves that they either earn profits or at least avoid incurring crippling losses. In all cases, it is the portfdolio size that determines the level of benefits a rational insurer can provide. 

\subsection{Maximum Sustainable Benefits For Profits Of 5 Percent}
\label{sec:MaximumSustainableBenefitsforProfitsof5percent}

Insurers' Maximum Sustainable Benefit For Profits of 5\%\index{Maximum Sustainable Benefit For Profits of 5\%} ($MSBP5_N$)\index{$MSBP5_N$} is the highest portion of each premium dollar it can pay, throughout the year, and match $PI$'s probability (0.8413) of earning profits of at least 5\% at year end. To adjust for differences in PLRE variability, $MSBP5_N$ = 0.8000 - 1 * $\sigma_{e_{N}}$ because PLREs above 0.8000 do not yield such profits. Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Row 11, shows $MSBP5_{NHI}$ = 0.79715 and $MSBP5_{B}$ = 0.78419. $NHI$ and $B$ can pay higher benefits than $PI$ (0.7500), but $MSBP5_{D}$ = 0.6419 and $MSBP5_{E}$ = 0.3000. $E$ must cut $PI$'s benefits by 60\% because it is a veryt inefficient insurer. 

Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Row 12 shows dollar values of average policyholder benefits ($MSBP5_N$ * \$4,000). $NHI$, $B$, $PI$, $D$ and $E$ can provide average benefits of: \$3,189;  \$3,137; \$3,000; \$2,568; and \$1,200. Contrary to capitation advocates' claims, these reduced costs are really cuts in medically necessary and appropriate care, due to providers' inefficient insurance operations, not capitation-induced savings due to increased clinical efficiency. Since capitated providers cannot become more efficient risk managers they are compelled to deny care mfor their patients or risk financial ruin.